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**If paying by check, please make payable to Powell Products, Inc.
For credit cards, we accept Visa/MasterCard/Discover Only.**
Name:__________________________________________________________
Address:_________________________________________________________
______________City:__________________________State:_______Zip_________
Email:_________________________________Tel:_______________________
CC#:____________________________________________________EXP:_______3 Digit Code:_________
Rod Model:__________________________Serial Number:__________________
Date of Purchase: __________________
**If returning more than one rod, additional rod models, serial numbers, and dates of purchase can be listed in the blank area below**
Mailing address:
Powell Product, Inc.
343 Boulder Rd.
Royal, AR 71968
